Systolic Blood Pressure Outcomes Research Articles

Associations between Prenatal Exposure to Phthalates and Features of the Metabolic Syndrome in Males from Childhood into Adulthood.

Phthalate metabolites are detectable within the majority of the population. Evidence suggests that a prenatal exposure to phthalates may be associated with the subsequent risks of obesity and elevated blood pressure. We hypothesised that a prenatal exposure to phthalates would lead to an increase in adverse cardiometabolic parameters through childhood and adulthood. The maternal serum phthalate measurements from the stored samples taken from Gen1 mothers at 18 and 34 weeks gestation were examined in relation to the cardiometabolic measures in 387 male offspring from the Raine Study. Data from the Gen2 follow-ups between 3 and 27 years were used. The primary outcomes were analysed longitudinally using linear mixed models for the repeated measures. Non-alcoholic fatty liver disease (NAFLD) was assessed at 17 years using logistic regression. A consistent positive relationship was observed between a prenatal exposure to mono-carboxy-iso-octyl phthalate (MCiOP) through adolescence into adulthood with systolic blood pressure. There were no other consistent cardiovascular associations. Mid-levels of prenatal exposures to Mono-n-butyl phthalate (MnBP) were associated with a greater incidence of NAFLD. Detectable Mono-3-carboxypropyl phthalate (MCPP) was associated with a lower serum HDL-C through late childhood into adulthood, while a higher prenatal exposure to mono-iso-butyl phthalate (MiBP), was associated with a higher LDL-C at 22 years of age. A mid-level prenatal exposure to mono-2-ethylhexyl phthalate (MEHP) metabolites was associated with higher insulin in adulthood, while a higher prenatal exposure to the sum of the Di-(2-ethyl-hexyl) phthalate (DEHP) and Di-iso-nonyl phthalate (DiNP) metabolites was associated with higher fasting serum glucose in adulthood. In conclusion, our study demonstrated that higher prenatal phthalate exposures to some phthalate metabolites was associated with some adverse metabolic profiles through adolescence into adulthood, although the consistent themes were limited to a few metabolites and the outcomes of systolic blood pressure, fasting insulin and glucose.

Effects of walking in individuals with prehypertension and stage 1 hypertension in India: a randomised controlled trial

Background/Aims Physical activity, such as walking, is a cheap approach with a low risk of injury that can be used in daily life. The aim of this study was to determine the effects of low impact aerobic exercise training on resting blood pressure in patients with prehypertension and stage 1 hypertension specifically for people in India. Methods A total of 63 sedentary adults with prehypertension and stage 1 hypertension participated in the study. All sedentary adults were randomly allocated to either the study group (aerobic training) (n=30) or the control group (n=33). Those in the study group walked for 30 minutes, three times a week for 8 weeks at an intensity of 60–75% of their target heart rate. The control group received no training but followed their usual prescribed medication and diet. The primary outcomes of systolic blood pressure and diastolic blood pressure were measured at the end of every 2 weeks for 8 weeks. Secondary outcomes of pulse pressure, mean arterial pressure and pulse rate were calculated. Results Significant changes in various outcome measures in the study group were noted (systolic blood pressure=7.30 mmHg (95% confidence interval [CI] 2.14 to 3.00; P=0.001); diastolic blood pressure=6.50 mmHg (95% CI 1.23 to 4.04; pulse pressure=0.000; mean arterial pressure=6.77 mmHg (95% CI 1.46 to 3.84; P=0.000) and pulse rate=6.90 bpm (95% CI 1.73 to 3.43; P=0.000) when compared with those in the control group, who had non-significant changes. Conclusions The findings of the present study concluded that aerobic exercise training improves blood pressure.

Feasibility of a behavioral automaticity intervention among African Americans at risk for metabolic syndrome

BackgroundTargeting habit-development (behavioral automaticity) as part of healthy lifestyle behavior change interventions may improve the adoption and maintenance of healthful behaviors. Few studies, however, have evaluated the feasibility of using a habit-development approach to foster the adoption of recommended physical activity and dietary behaviors. We report quantitative and qualitative data from a feasibility study evaluating a habit-formation intervention to foster healthy dietary and physical activity habits among middle aged African Americans with metabolic syndrome.MethodsUsing a non-comparative design we evaluated the feasibility an 8-week, hybrid format (telecoaching and face-to-face sessions), habit-focused intervention targeting the development of healthful dietary and physical activity habit development among 24 African Americans aged 40 and older with metabolic syndrome recruited from the emergency department – a setting where individuals in under-resourced communities often go for primary care. We administered behavioral automaticity measures tailored to participants’ self-selected habits biweekly during the intervention and collected clinical outcomes of systolic blood pressure, weight, waist circumference, and BMI at baseline week 20.ResultsParticipant attrition from the program was high (~ 50%). Despite high levels of attrition, 92% of intervention completers were extremely satisfied with the program. Intervention completers also experienced gains in behavioral automaticity for both dietary and physical activity habits. Overall, higher levels of adherence were associated with higher positive gains in automaticity with the statistical significance of the associations being more pronounced for physical activity habit plans relative to dietary habit plans.ConclusionsOur preliminary data support a habit-development approach for fostering the adoption of healthful dietary and physical activity habits. However, in this pilot study high rates of attrition were seen, suggesting that strategies to improve retention and participant engagement should be included in future studies, particularly when targeting African American emergency department patients.Trial registrationClinicalTrials.gov ID: NCT03370419 Registered 12/11/2017, retrospectively registered.

Abstract 096: Comparing Strategies to Improve Systolic Blood Pressure Over 10 Years: A Simulation Study Using the Blood Pressure Control Model

Background: Uncontrolled hypertension increases patients’ risk for cardiovascular and kidney disease. This study compared strategies to improve systolic blood pressure (SBP) among 1000 simulated patients with uncontrolled hypertension (SBP >=140 mmHg) from the National Health and Nutrition Examination Survey (NHANES). Methods: The Blood Pressure Control Model (BPCM) is a microsimulation, health state transition model that predicts the weekly SBP of patients receiving usual care. In the BPCM, patient SBPs are estimated using office visit frequency, measured SBP accuracy and variability, probability of treatment intensification with uncontrolled SBP, effect of antihypertensive medications, and adherence. BPCM inputs are derived from national survey data, meta-analyses, and other published literature. The effects of usual care on SBP were compared to 10% and 50% increases in global strategies for SBP control (i.e., visit frequency, treatment intensification, and/or adherence) over 10 years. SBP outcomes were validated against published literature values of 44-46% prior to implementation (i.e., usual care) and 74-80% 8-10 years after implementation of aggressive hypertension management programs in large health systems. Results: In the simulated NHANES population, the mean (SD) age was 61.1 (14.6), 52% were male, and mean baseline SBP was 153.2 (13.6) mmHg. Under usual care, the BPCM estimated a mean SBP of 140.1 (16.4) mmHg and 49% of patients achieving SBP <140 mmHg after 10 years. Compared to usual care, 50% improvements in global strategies resulted in more rapid reductions in SBP and earlier achievement of SBP control. Simultaneously improving all global strategies by 50% resulted in an estimated mean SBP of 132.4 (15.5) mmHg with 71% achieving control after 10 years. Conclusions: Usual care and intervention BPCM predictions are consistent with hypertension control rates observed in contemporary national surveys and the observed results of recent systematic hypertension control improvement programs. These results show the BPCM may be used by health system planners to project the impact of implementing hypertension control strategies.

Rationale and design of the Primary pREvention strategies at the community level to Promote Adherence of treatments to pREvent cardiovascular diseases trial number (CTRI/2012/09/002981)

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality in low-income countries including India. There is a need for effective, low-cost methods to prevent CVDs in rural India. One strategy is to identify and implement interventions at high-risk individuals using community health workers (CHWs). There is a paucity of CHW-based CVD intervention trials from low-income countries. We designed a multicenter, household-level, cluster-randomized trial with 1:1 allocation to intervention and control arms. The CHWs undertook a door-to-door survey and screened 5,699 households in 28 villages from 3 rural regions in India to identify at-risk households. The households were defined as those with ≥1 individual aged ≥35 years and at moderate or high risk for CVD based on the non-laboratory-based National Health and Nutrition Examination Survey score. All at-risk individuals were invited to attend a physician-led village clinic that provided a CVD risk reduction prescription and education about target risk factor levels for CVD control. All households in which at least 1 member at moderate to high risk for CVD had received a risk reduction prescription were eligible for randomization. Households randomized to the CHW-based intervention will receive 1 household visit by a CHW every 2 months, for 12 months. During these visits, CHWs will measure blood pressure, ascertain and reinforce adherence to prescribed therapies, and modify therapy to meet targets. Households randomized to the control arm do not receive CHW visits. At 12 months after randomization, we will evaluate 2 primary outcomes of systolic blood pressure and adherence to antihypertensive drugs and secondary outcomes of INTERHEART risk score, body mass index, and waist-to-hip ratios. At 18 to 24 months after randomization and 6 to 12 months after the last intervention, we will record these outcomes to evaluate sustainability of intervention. Community health workers screened a total of 5,033 households that included 9,248 individuals and identified 2,571 households with 3,784 at-risk individuals. We randomized 2,438 households (1,219 to intervention and 1,219 to control groups). Our large trial of CHWs in rural India will provide important information regarding a promising approach to primary prevention of CVDs.

The effects of health education on patients with hypertension in China: A meta-analysis

Objective: This study collected on from all research relating to health education and hypertension in China and, with the aid of meta-analysis tools, assessed the outcomes of such health education. The analysis provides a basis for the further development of health-education programmes for patients with hypertension. Methods: Literature searches were carried out to identify studies that had evaluated the impact of health education on hypertension in China. The time interval searched was from 1 January 1991 to 31 December 2010. We searched the databases of PubMed, CBM, CNKI and VIP. Strict inclusion and exclusion criteria were used to screen the literature. We generated meta-analyses, using Cochrane RevMan 5.0 software, of outcomes of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: Fourteen studies met the inclusion criteria. Results show that, after health education for patients with hypertension, SBP and DBP is substantially lowered; the effect was statistically significant ( P < 0.001). We extended subgroup analyses of the separate effects on SBP and DBP with respect to follow-up time, intervention site, intervention method and age. Conclusion: This review confirms that health education plays an important role in blood pressure control in hypertensive patients (especially the elderly): short-term follow-up intervention was more effective, and the effects were similar whether intervention was at the hospital or at the community level.

1106 INVERSE ASSOCIATIONS OF GUT MICROBIAL DERIVED CO-METABOLITES WITH BLOOD PRESSURE

Background: The gut microbiome has been implicated in blood pressure (BP) variation and cardiovascular disease. Methods: Eight random population samples, 2,000 Americans ages 40–59 in the International Study of Macro/Micronutrients and Blood Pressure (INTERMAP); eight BP measurements at four visits; 24-h urinary sodium, potassium excretion, and most abundant urinary gut microbial co-metabolites, measured by ultraperformance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) from two 24-h collections per individual. Associations between gut microbial metabolites and BP assessed by multiple linear regression. Results: 24-h urinary hippurate, 4-cresylsulphate (4CS) and phenylacetylglutamine (PAG) were inversely associated with diastolic BP (P = 0.002 to P = 9.2 x 10–5 for 4CS), as was the 4CS/PAG ratio (P = 0.01 to P = 1.9 x 10–6); regression coefficients per 2 SD difference ranged from -1.03 to -1.99 mm Hg for the 4CS/PAG ratio (Table). Results for systolic BP were also inverse, though not all significant. Table. Estimated mean differences in diastolic BP (mm Hg) per 2 standard deviation (SD) higher excretion of UPLC-MS/MS derived gut microbial metabolites. INTERMAP US samples, men and women combined* (N = 2,000)Interpretation: Both phenylalanine and tyrosine can be converted to the potent vasopressors β-phenylethylamine and tyramine, respectively, by bacterial putrefaction processes in the distal colon; PAG and 4CS are in related, directionally opposite, pathways, but non-vasoactive. Their inverse associations with BP may reflect activity of competing putrefactive microbial pathways away from sympathomimetic amine production. Gut microbial co-metabolism may have a role in BP regulation.

Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial

participation in centre-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality but participation rates among the elderly are low. Establishing alternative programmes is important, and home-based CR is the predominant alternative. However, no studies have investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up. randomised clinical trial comparing home-based CR with comprehensive centre-based CR among patients ≥ 65 years with coronary heart disease. seventy-five patients participated. There were no significant differences in exercise capacity after the intervention between home and centre-based CR. Adjusted mean differences of peak VO₂ = 0.9 ml/kg/min (95% CI -0.7, 2.4) and of 6 min walk test = -18.7 m (95% CI -56.4, 18.9). In addition, no differences were found in the secondary outcomes of systolic blood pressure (-0.6 mmHg, 95% CI -11.3, 10.0), LDL cholesterol (0.3 mmol/l, 95% CI -0.04, 0.7), HDL cholesterol (0.2 mmol/l, 95% CI -0.01, 0.3), body composition, proportion of smokers and health-related quality of life. A group of patients who did not have an effect of either programmes were characterised by higher age, living alone and having COPD. At 12 months of follow-up, both groups had a significant decline in exercise capacity. home-based CR is as effective as centre-based CR in improving exercise capacity, risk factor control and health-related quality of life. However, a group of patients did not improve regardless of the type of intervention. Continued follow-up is essential in order to maintain the gained improvements.

Can sibutramine alter systemic blood pressure in obese patients? Systematic review and meta-analysis

Systemic arterial hypertension is part of the metabolic syndrome resulting from obesity. To evaluate the effect of sibutramine on overweight and obese patients' blood pressure through a systematic review. All the studies included needed to be randomized controlled trials. The methodological quality of the selected trials was assessed using the criteria described in the Cochrane Handbook. The participants were overweight and obese patients; the intervention was sibutramine compared with placebo. The primary outcome measurement was systolic and diastolic blood pressure and the secondary measurement was blood pressure. Studies were identified by searching the following sources: Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Medline, Cochrane reviews, manual searches, personal communication and contact with the pharmaceutical industry. There were no language, date or other restrictions. Data collection and extraction was performed by two reviewers, who independently obtained the full articles of all eligible papers. Three meta-analyses were produced: 1) systolic blood pressure outcome (eight studies) did not show statistical significance between sibutramine and placebo: weighted mean difference (WMD) 1.57, confidence interval (CI) -0.03 to 3.18; 2) diastolic blood pressure outcome (ten studies) did not show statistical significance between sibutramine and placebo: WMD 1.13, CI -0.49 to 2.76; 3) blood pressure outcome (two studies) also did not show statistical significance between the groups: relative risk (RR) 0.69, CI 0.07 to 7.01. The meta-analyses presented in this systematic review show that sibutramine does not have a statistically significant effect on blood pressure, compared with placebo.